Hemodialysis for Lithium Intoxication: Preliminary Guidelines for Emergency

Kasahara, Hiroo; Shinozaki, Toru; Nukariya, Kazutaka; Nishimura, Hiroshi; Nakano, Hiroshi; Nakagawa, Tanehide; Ushijima, Sadanobu

doi:10.1111/j.1440-1819.1994.tb02990.x

Cited by 3 publications

(1 citation statement)

References 9 publications

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“…2). Hemodialysis is also reportedly a useful detoxiˆcation method for lithium, especially in patients with serum lithium levels higher than 3.5 mEq/l or renal impairment 1,8,28) .…”

Section: Discussionmentioning

confidence: 99%

Detoxication Treatment for Carbamazepine and Lithium Overdose

et al. 2008

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This article reports detoxication treatments of a case of combined overdose of carbamazepine and lithium in a 38-year-old female with bipolar disorder. She was brought to the emergency unit after the family found her unresponsive and lying near empty packages for carbamazepine (corresponded to 7.7 g) and lithium carbonate (corresponded to 6.6 g) tablets. On admission, her blood pressure, heart rate and respiratory rate were 80/55 mmHg, 90 per minute and 13 per minute, respectively. Her GCS was 3 (E1, M1, V1). She received gastric lavage after intratracheal intubation, followed by administration of activated charcoal via gastric tube, and a large volume (800 ml/h) of lactate Ringer's solution by intravenous infusion. The serum levels of carbamazepine and lithium approximately 5 h after ingestion were 56.0 mg/ml and 3.56 mEq/l, respectively. The carbamazepine overdose was mainly treated by a 3 h charcoal hemoperfusion (CHP). The CHP treatment decreased serum carbamazepine levels by approximately 30 40％ as compared with the levels simulated by Bayesian analysis using 1-point or 2-points serum level(s) (without detoxication treatment). For lithium overdose continuous infusion of Ringer's solution was eŠective, which increased serum sodium gradually and facilitated the elimination of lithium. In conclusion, the treatments with CHP and continuous infusion of Ringer's solution were considered to be eŠective for detoxiˆcation of carbamazepine and lithium overdose, respectively, when compared with those drug levels without detoxication treatment that simulated by Bayesian analysis method.

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“…2). Hemodialysis is also reportedly a useful detoxiˆcation method for lithium, especially in patients with serum lithium levels higher than 3.5 mEq/l or renal impairment 1,8,28) .…”

Section: Discussionmentioning

confidence: 99%

Detoxication Treatment for Carbamazepine and Lithium Overdose

et al. 2008

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Permanent Cerebellar Degeneration After Acute Hyperthermia with Non-toxic Lithium Levels: a Case Report and Review of Literature

Rossi

Hoffmann

et al. 2017

Cerebellum

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This was a study of a 33-year-old man with bipolar disorder treated with lithium who developed cerebellar atrophy after an event of extreme hyperthermia. Unlike previously reported cases of acute cerebellar atrophy after heat stroke, neuroleptic syndrome or lithium toxicity, this case was characterized by a chronic cerebellar atrophy that developed after sepsis-induced hyperthermia in the setting of non-toxic lithium levels. Unique to this case also was the early finding of cerebellar atrophy on MRI 2 weeks after the episode of hyperthermia, long-term neurotoxicity after the novo lithium therapy, and longest follow-up case of chronic cerebellar syndrome after hyperthermia with non-toxic lithium levels.

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Extracorporeal Treatment for Lithium Poisoning

Decker¹,

Goldfarb²,

Dargan³

et al. 2015

Clinical Journal of the American Society of Nephrology

147

139

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on behalf of the EXTRIP Workgroup Abstract The Extracorporeal Treatments in Poisoning Workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments in poisoning. Here, the EXTRIP workgroup presents its recommendations for lithium poisoning. After a systematic literature search, clinical and toxicokinetic data were extracted and summarized following a predetermined format. The entire workgroup voted through a two-round modified Delphi method to reach a consensus on voting statements. A RAND/UCLA Appropriateness Method was used to quantify disagreement, and anonymous votes were compiled and discussed in person. A second vote was conducted to determine the final workgroup recommendations. In total, 166 articles met inclusion criteria, which were mostly case reports, yielding a very low quality of evidence for all recommendations. A total of 418 patients were reviewed, 228 of which allowed extraction of patient-level data. The workgroup concluded that lithium is dialyzable (Level of evidence=A) and made the following recommendations: Extracorporeal treatment is recommended in severe lithium poisoning (1D).

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Hemodialysis for Lithium Intoxication: Preliminary Guidelines for Emergency

Cited by 3 publications

References 9 publications

Detoxication Treatment for Carbamazepine and Lithium Overdose

Detoxication Treatment for Carbamazepine and Lithium Overdose

Permanent Cerebellar Degeneration After Acute Hyperthermia with Non-toxic Lithium Levels: a Case Report and Review of Literature

Extracorporeal Treatment for Lithium Poisoning

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